Plan Premium | Medical Maximum out of pocket | Additional Benefits (these are benefits not covered by Medicare) | $0 You must continue to pay your Medicare Part B premium | $3,400 |
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Common Medical benefits and your copays - remember that if you reach your Medical Maximum Out of Pocket limit, the rest of your Medicare-covered medical services are paid by CommunityCare
Doctors Visits provider search | $0 for Primary Care $20 for Specialist |
Emergency & Urgent Care – Worldwide coverage | $190 for Emergency Room - waived if admitted $20 for Urgent Care |
Outpatient Hospital | $125 copay |
Outpatient Rehab (such as Physical Therapy) | $20 copay per visit |
Outpatient Diagnostic Services | $0-$125 copay, depending on the service |
Inpatient Hospital | $100 copay each day for days 1-7 |
This plan does not include Part D coverage for outpatient prescription drugs. Please note that you cannot have Advantage Medicare Plan Choice and another company’s Part D plan. If you do not have creditable coverage (as good as Medicare Part D), you may incur a penalty if you enroll in a Part D plan at a later date. Examples of creditable drug coverage are Indian Health Services or Veteran’s benefits.
You can call our Medicare team at 918-594-5275 for more information on this plan or other options. We are available Monday through Friday from 8:00 to 6:00.